Healthcare Provider Details

I. General information

NPI: 1992071047
Provider Name (Legal Business Name): CHETAN JITENDRA PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 NARCOOSSEE RD STE 209
ORLANDO FL
32832
US

IV. Provider business mailing address

12601 NARCOOSSEE RD STE 209
ORLANDO FL
32832-7144
US

V. Phone/Fax

Practice location:
  • Phone: 407-605-3777
  • Fax: 321-473-4839
Mailing address:
  • Phone: 407-605-3777
  • Fax: 321-473-4839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME133810
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME133810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: